Provider Demographics
NPI:1679576631
Name:DIFFINE, DAVID ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ARTHUR
Last Name:DIFFINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-1425
Mailing Address - Country:US
Mailing Address - Phone:870-824-2809
Mailing Address - Fax:870-762-0731
Practice Address - Street 1:1100 MEDICAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1425
Practice Address - Country:US
Practice Address - Phone:870-824-2809
Practice Address - Fax:870-762-0731
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000148413207Q00000X
ARE-3767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR150606001Medicaid
MO205143001Medicaid
MO9494A1OtherMO BLUECROSS BLUESHIELD
MO595409004Medicaid
AR5M707OtherBLUE CROSS OF ARKANSAS
MO205143001Medicaid
MO595409004Medicaid
AR5M707Medicare PIN
MO205143001Medicaid
MO9494A1OtherMO BLUECROSS BLUESHIELD